Effective patient treatment is dependent upon a variety of imaging procedures, yet oftentimes hospitals and health systems lack a clearly defined strategy and infrastructure for managing or evolving enterprisewide imaging. While individual departments may have their disparate imaging systems functioning within closed walls, the shifting focus on integrated delivery and open-walled organizations necessitates another look at organizations' enterprise imaging programs. This need has been exasperated by the increasing healthcare trend of consolidation via mergers and acquisitions.
Here, Shawn McKenzie, CEO of Ascendian Healthcare Consulting, discusses enterprise imaging transformation for hospitals and health systems and shares keys to success as hospital leaders consider enterprisewide imaging initiatives.
Note: Answers have been lightly edited for length and clarity.
Question: What role does governance play in enterprise imaging transformation?
Shawn McKenzie: Governance is the keystone to the transformative process driving enterprisewide change. It is the basic building block to the development and deployment of a successful strategy and the initiation of a series of tactical projects. In healthcare for some reason we seem to fall back to the established hierarchy or organization chart to define a governing body for a project. This is a good starting point since a report structure is important, but you can organize the governing body by increasing diversity across key stakeholders and resources that are operationally driving things so the nuance and details are revealed and the impact behind what the project will do to change codified workflows into the service line. Without a good governing body the project has a much higher propensity to fail.
We used to think of medical imaging as radiology- or cardiology-specific. If we look at what imaging has become, [we have to] redefine imaging outside radiology and cardiology because imaging has expanded to incorporate any department that acquires, interprets, utilizes or archives a visual data object in the process of providing care. As we transform imaging and cast it under a new light, governance must incorporate an entirely new set of service lines “ologies” and departments producing medical important images or visual objects into this governing body. It doesn't need to occur all at once. If your organization is focusing on transformation in radiology first, the governing body needs to have representation from that service line. As you move over to other departments like pathology, endoscopy, etc., your governing body will require a shift as the iterative adoption moves through phases of the project. The biggest thing the governing body must have, which I see fail all the time, is ultimate authority to act and make decisions for the enterprise while balancing the more specific and detailed needs of individual departments. This includes the softer skills of managing the culture and politics of those departments.
Q: How do governing bodies work through those politics and competing agendas?
SM: It starts with understanding the goal line and being able to clearly articulate the vision. People become very nervous when their department that has been very unique to them and driven to meet their specific requirements is looked at from the enterprise perspective. Being able to — and this is the hardest part — articulate the long-term goal and strategy of the enterprise imaging transformative process, and to address each individual service line in a way that defines their role and how important it is to engage in this process knocks down a lot of barriers.
I've seen enterprise initiatives being driven from [the] top with a mandate and statement like, “This is the way it's going to be, and you don't have any choice." Much of the drive to push enterprise systems implementations with little regard for how they may affect the clinical workflow of the care providers is financially driven. Healthcare organizations spend millions of dollars to consolidate and converge their IT ecosystem. The financial element is one consideration, but without a governing body that considers changes in workflow and the ability to sustain quality by the caregivers, the project will risk death by a thousand cuts generated from slow or limited adoption. You've got to have a diverse governing body with the emotional intelligence capable of articulating why and how the organization will approach transformative changes.
Q: What vision and strategic criteria should be included in an enterprise imaging business plan?
SM: I ask executives all of the time, "What is your enterprise imaging strategy?" More often than not I get blank stares. You've got all of these departments that are producing medical images that have to be incorporated somehow into the comprehensive patient jacket. What is your strategy? Are mergers and acquisitions part of growth strategy? That all folds into the enterprise imaging business plan because if you're going to absorb a third party through a merger or acquisition, what due diligence is being spent in looking at their current imaging ecosystem and the cost it's going to take to fold them into the mothership? That factor is a single example of what is overlooked constantly. A business plan depends on what environment you currently have in contrast to a well defined vision of what imaging will become.
My question has always been, if there's a business plan to be developed, who within the organization can articulate the overall strategic goals of every single business unit producing medical images?
Q: Who would you say that person is?
SM: Somebody who understands the idiosyncrasies of medical imaging and is knowledgeable of emerging technologies capable of facilitating the change. A lot of time it falls to a vice president of allied health or ancillary services. But they often look to fill the gaps with operations resources that tend to be granularly focused on day-to-day operations and do not have the time, knowledge and market exposure to offer a fresh look. So, without that internal knowledge, organizations ask their vendors to assist with the strategy. This tends to lead to a strategy circled around the vendors offering. It does not develop the strategy where an organization can shop the market for vendors that fit the strategy. I find it amazing that we overlook arguably one of the top 5 revenue producing service lines in healthcare when considering a strategic work plan. We look at the top 10 areas of interest for CEOs, CIOs and CFOs, and medical imaging is never even in the top 10. Perhaps it is because it is arguably one of the most difficult technologies to deal with. Imaging has always been complicated, and now that an imaging transformative strategy includes image sharing with affiliated and non-affiliated entities, you add a multiplier of complexity that demands expertise not normally found in-house. I can assure you based on my years of clinical and operations experience, if imaging goes down for some reason or is ineffective, it affects the entire care continuum.
Q: How do you accelerate adoption and optimization between operations, clinicians and IT?
SM: This goes straight back to governance question that emphasizes the requirement of an effective governing body. When everybody understands the goal and you solicit input from the key stakeholders — which are from operations, clinical staff and IT — those three entities and cultures form the three-legged stool to any project. Adoption and optimization occur organically when the dialogue between those three is honest, clear and detailed. That's the function of the governance committee. Adoption is about communication across technology, process, people and strategy components. One of my favorite [sayings] is: Culture eats technology for lunch every time. So let's address the culture, let's address the known hindrances related to our culture to the governing body and then find the tools and the tech solutions that fit!
Q: What does success and ROI look like from an executive's perspective?
SM: That's the $20 million; no let’s say the $100 million question. I love this question because it's like nailing Jell-O against the wall. You can look at an ROI from multiple different perspectives. If it's quantitative, you need to define where the cost adjustments or increased revenues reside. What does the organization have today that will transition with the new strategy if at all? How can you know what will be kept and what will be going if you cannot articulate the desired goal? It is only by knowing those components that anyone can actually conjure a viable and measured ROI statement. I can say that some ROI components can be realized from tech convergence. The general state of medical imaging right now is a disparity of siloed databases and archive spaces. Every single one of them requires a lot of cost for ongoing feeding and caring of these systems. When you have a strategy that incorporates a convergence of these technologies, then naturally you can see a lower cost.
That's quantifiable, and in general you can find variations of an ROI. But this is where the road splits. Do we want to look for an ROI based upon the old fee-for-service model or seek a return on what is the still emerging pay-for-performance model? Based on the fee-for-service, the ROI calculations can be fairly basic, “Do more for less”. The other model ROI is not as simple, “Do it, but prove you did it right”. If we're looking for ROI as it relates to the latter, which is pay-for-performance, then we must have a strategy for systems convergence and interoperability as that is the only way we're going to be able to drive analytics to measurable outcomes.
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